hello anatomy colleagues this is dr. Alsup and we will be reviewing the pertinent nerves for the
pterygopalatine fossa and palate session and there are really quite a few but the majority
of these will be branches of the maxillary nerve or v2 but let's start our conversations on those
that are not branches of V2 starting with a quick review here of the location of the bulk of the
mandibular nerve or v3 which is basically here and you can see the expanse of the branches of
v3 we know that the mandibular nerve will exit the skull via the foramen ovale and that is what we're
seeing right here is about where it exits it's a large nerve and you can have a nice view of the
posterior division in its anterior divisions there and just note that this nerve will send a branch
to the tensor veli palatini which is typically coming off the nerve to the medial pterygoid so
that is a branch of v3 we also need to review the glossopharyngeal nerve which as we know plays a
major role in terms of afferent innervation to both the oro- and the laryngopharynx as well as
efferent innervation to the stylopharyngeus but don't forget that it will also provide general
and in taste sensation to the posterior tongue and so let's locate it right here it's going to
be this nerve right in this region and excuse me you can see that it's going to be just inferior
to the tonsillar fossa region between the Palatoglossal and the palatopharyngeus
arches with arches in this region right here is the tonsillar fossa you can see a bit of
the tonsillar tissue and so this any type of surgery that occurs in the tonsillar region or
the palatine tonsillar region really needs to consider this closed inferior relationship of
the glossopharyngeal nerve all right one of my all-time favorites is the pterygopalatine ganglion
and so that is going to be located in this general region right here you can see where it gets a
little bit larger more circular right there this is the largest peripheral parasympathetic ganglion
and it's located medial and inferior to the bulk of v2 and because of its close relationship to v2
many of the branches of the maxillary nerve will travel through this ganglion without synapsing
because only preganglionic parasympathetic fibers originating from the facial nerve
through the branch of the greater petrosal nerve will synapse here and that greater petrosal nerve
will join with the deep petrosal nerve which contains postganglionic sympathetic fibers to
form the nerve of the pterygoid canal which you can see here it's hard to differentiate
between the artery just know that that artery and nerve travel in this general region and the
nerve of the terror of the pterygoid canal will enter the tear go palatine ganglion posterior
as you can see it doing here so it is here that those preganglionic parasympathetic fibers will
synapse and so that's key only those pre ganglionic s' will synapse there you may
have many other fibers traveling through this region that do not synapse alright let's turn
our attentions to the branches of the maxillary nerve or v2 and why not start with the big one
the infraorbital nerve the improbable nerve which you can see here in the floor of the orbit before
it's entering the infraorbital canal where it will give off some alveolar branches and you
can also see it kind of all over the place all its branches exiting through the infraorbital foramen
the infraorbital nerve is a is the terminal branch of v2 and it's typically the largest branch let's
work through the v2 branches that will a fairly serve the teeth and in order to understand which
one is which making sure you understand what is anterior and what is posterior is important so it's going
to be anterior here towards the incisors and the nose and then this will be more posterior
towards the molars and the ear region so it kind of helps in terms of being able to understand
which branches go where the posterior superior alveolar branch so the P P S A excuse me it's
going to be more in this direction and it's heading towards the molars which you can see
here the posterior superior alveolar branch is a direct range of V to both the middle and the
anterior superior alveolar branches are typically branches of the infraorbital nerve and sometimes
the middle branches are missing these closer to the premolars are going to be MSA branches or
middle superior alveolar and then the ones that are heading towards more towards the incisors
as well as the canine will be the a SA or the anterior superior alveolar branch now this whole
region here you can see that the the nerve branch has become increasingly smaller and they kind of
spread out in a larger area actually would extend this way as well this will be the superior dental
flex I said these are the small branches that are directly associated with those the teeth in terms
of the a fair and innervation so these are just smaller branches of these nerves that we just
talked about here all right let's head towards the palate region and we're having so much fun
I can hear that my computer is just getting hot and excited to talk about this I'm sorry
if there's some background noise all right the hard palate is going to be a fairly innervated
by the greater Palatine nerve so the GP more posterior lis it's going to enter the region
through the greater Palatine foramen it will be a ferret or it will be a parently innervated in
the more anterior portions by the nazo paletine nerve which will enter into this region or old
traverse this region via the incisive foramen the lesser Palatine nerve will a parent Li serve the
soft palate and these are easiest to locate from the soft palate region heading towards
the lesser paletine foramina which will be right in this region there's usually multiple lesser
Palatine foramina so this these particular nerves will be lesser paletine so you'll have arteries
as well for for these that are going to travel with the nerves so it's sometimes difficult to
distinguish between the arteries and the nerves just focus on understanding what neurovascular
is right there because in terms of a practical setting we typically don't ask to differentiate
between the arteries and nerves last but not least there are some v2 branches that
innervate the lateral nasal wall region which we are looking at here you can see here is going to
be the posterior inferior nasal nerve branches right around this region these are and there
are near these arterial branches of the sphenoid paletine the posterior inferior nasal branches
are branches of the greater Palatine nerve which comes off these particular nerve branches come off
within the greater Palatine canal and then head to the nasal wall and then up here we
have posterior superior lateral nasal branches which are direct branches from v2 and these will
innervate poor the posterior portions of the lateral nasal wall and superior middle nasal
conchae all right so that wraps up our coverage of the nerves of this session please take time
to review your understanding of the location of these structures and always please feel free to
reach out to me or any of my Anatomy colleagues with quest thank you for your time and attention